Local therapeutic strategies for neurocutaneous dysesthesia: from capsaicin to cannabinoids

Neurocutaneous dysesthesia (ND) is characterized by abnormal skin sensations such as pruritus or burning without an underlying skin condition. It is caused by nerve damage or compression. Location and extent of symptoms vary greatly depending on the affected somatosensory site(s). Treatment is challenging and step-by-step guidelines are lacking. Local therapy offers a valuable first step, especially in mild cases or when systemic agents are contraindicated. Although numerous studies have described a variety of local treatment options for ND, no clear overview of these options existed.

In this review, we provide an overview of available local treatment modalities for ND and explain their mechanisms of action.

The following local treatment options are described: capsaicin, calcineurin inhibitors, menthol, pramoxine/lidocaine/prilocaine, ambroxol, phenytoin, strontium, amitriptyline, doxepin, duloxetine, baclofen, gabapentin, cannabinoids, loperamide, naltrexone, clonidine, prazosin, acetylsalicylic acid, diclofenac, aprepitant, ketamine, calamine, polidocanol, and botulinum toxin type A.

Local therapy offers a valuable and often well-tolerated first step in managing ND. Unfortunately, high-quality evidence is scarce and treatment efficacy remains unpredictable. Clinicians are advised to start with low concentrations, discuss off-label use, and monitor for side effects. Until robust guidelines are available, a cautious trial-and-error approach remains the cornerstone of management.